Social determinants of health, clinical outcomes, and healthcare resource utilization in participants with and without narcolepsy in the All of Us research program.

Abstract

Study objectives: Evaluate the clinical and economic burden and impact of social determinants of health (SDoH) in narcolepsy.

Materials and methods: This retrospective, observational study used electronic health record and survey data from the All of Us Research Program (1/1/2009-7/31/2022). Participants with narcolepsy were matched 1:3 to participants without narcolepsy. Descriptive statistics and regression analyses (odds ratios [ORs]) summarized demographics, clinical comorbidities, and SDoH; hazard ratios (HRs) estimated risk of incident hypertension, hyperlipidemia, obesity, and coronary arteriosclerosis (CA); and incidence rate ratios (IRRs) estimated healthcare resource utilization (HCRU).

Results: The sample comprised 2766 participants (narcolepsy, n = 694; non-narcolepsy, n = 2072; mean age, 49 years; 70 per cent female). Despite high education levels, greater proportions were out of work/the workforce in the narcolepsy versus non-narcolepsy cohort (38.5 per cent vs. 29.2 per cent). Among SDoH survey respondents, greater food insecurity, loneliness, and everyday/medical discrimination, and less social support/cohesion were reported in the narcolepsy (n = 259) versus non-narcolepsy (n = 768) cohort. Individuals with versus without narcolepsy had higher odds (OR [95 per cent confidence interval; CI]) of cardiovascular (1.76 [1.35-2.28]), cardiometabolic (2.12 [1.73-2.59]), and renal (2.47 [1.72-3.56]) comorbidities; higher risk (HR [95 per cent CI]) of developing hypertension (2.00 [1.51-2.65]), hyperlipidemia (1.96 [1.52-2.54]), obesity (2.42 [1.93-3.05]), and CA (1.75 [1.27-2.42]); and increased HCRU (IRR [95 per cent CI]) for inpatient days (2.07 [1.55-2.78]), outpatient visits (1.51 [1.35-1.70]), and emergency department visits (1.70 [1.19-2.43]).

Conclusions: Narcolepsy is associated with employment barriers, SDoH-related disparities, and elevated comorbidity burden and risk. Comprehensive and timely management strategies are needed to address whole-person health.